Bill Klaproth (Host): Welcome to the ASHRM Podcast, made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org, that's ashrm.org/membership to learn more and to become an ASHRM member. I'm Bill Klaproth. And on this podcast, we talk with Karen Markwith about her journey as a healthcare risk professional. Karen is the Northwest Region Director of Risk Management Operations with CommonSpirit. Karen, welcome to the podcast.

Karen Markwith: Thank you, Bill, for having me. Looking forward to our discussion.

Host: Yeah, me too. We're looking forward to learning more about you. So, Karen, could you start off by telling us, how did you get into risk management?

Karen Markwith: It's been quite the journey. I was the Director of Acute Care Services for our community hospital, and I had my own risk manager. And we were having lots of reductions in staff. And I was in the middle of raising our four boys, and it was getting a little more tougher and tougher. And my girlfriend had let me know about our health system had bought out a medical group, and they were looking for a risk manager. So, I went to my risk manager and said, "Can I do this?" And she became my mentor and she said, "You're critical thinking, you think on your feet. Absolutely." So, I applied. I got the position. That's it. And then, I was the first risk manager for this medical group, my first job, not knowing what I was doing, basically. And my first mentor was my risk manager from my hospital. So, she just threw me into a bunch of education, gave me a bunch of books, got me into our state association, was going to education there.

Our health system belonged to Catholic Health Initiative. And so, they took all the risk managers to ASHRM. So, I went to ASHRM my first three months of being a risk manager. And then, they had their own education. So, that's how I became a risk manager. And then, I continued to build my skills in the ambulatory field. And as that was built, I was promoted to director of provider services. And then, the hospital where I used to work from needed a risk manager. So, they transferred me back over to the hospital that I worked at. And then, my first hour, my first day, I was on an interview panel for the Director of Risk Management for the health system. And I thought, wait a minute, "Why didn't I apply for the director risk management for the health system?"

So then, I turned around and they hired this gal that we interviewed. But unfortunately, she did not work out and so they turned around said, "Hey, weren't you a director?" I'm like, "Yes." So, they promoted me to director, the health system's risk manager for the area. And then, I worked on that risk program, had my staff, and then turned around and our corporate entity, CHI, was reorganizing their risk program, and they asked me to go to corporate and be the regional risk manager.

So, I did that for a while, representing Washington, Oregon. And then, turned around and worked on a lot of big projects, and then turned around and we re-orged again. So then, I ended up working for a health system, Virginia Mason in Seattle, became their Director of Patient Safety. And then, their Director of Risk Management left a year later, and they said, "Hey, didn't you used to do risk management?" So, they gave me the Director of Risk Management, Patient Safety. And then, that health system, Virginia Mason, aligned with my previous health system, CHI Franciscan, which was then part of CHI, which was then bought out by CommonSpirit. So now, I'm the Northwest Region Director of Risk Management operations with Washington, Oregon. So basically, I'm back to where I started.

Host: Yeah, that is quite a journey. There was a lot of twists and turns, but here you are.

Karen Markwith: Here I am.

Host: I love it. Hey, you were mentioning early on that your first mentor, if you will, was your very first risk manager. I love asking about mentors and people that helped you early in your career. How did she make a difference early on in your career?

Karen Markwith: She knew everything. She knew it was the pulse of the hospital, which was always amazing to me. As director of acute care, I'd be on one of my floors. I looked down the hallway. There was my Miss Julie with her hands on her hips. I knew something was going on. So, it was like, "How did she know what was going on in my building or my floor without..." or I just found out. So, she had a really good pulse on it. So, that made me really like, "How'd you get there? How do you know this? And she said a really, really good advice, which I would give to a new risk manager too, find meetings that you should belong to and start inviting yourself. Get in, lean in, you know. And so, she did that so much that people became trusting to her, let her know what's going on immediately. So, she really did have the pulse of our hospital. I thought that's a great characteristic that I want to continue to build on. And then, of course, she threw books at me and let me know about the state properties of our program. So, she was always saying, "You got to go to this, got to do this, got to do this." And then, of course, she was my go-to, my hotline. So, that was my first mentor.

Host: It's great to have someone like that kind of clearing the path for you. So, what did she say? Find meetings you should belong to and invite yourself in?

Karen Markwith: Invite yourself in.

Host: Yeah. Is that something you have done then in your risk management career?

Karen Markwith: Yes. Well, when I first became a risk manager at the Franciscan Medical Group, I became the first risk manager. They gave me an office. They gave me a computer and said, "Bye, see you."

Host: "Okay."

Karen Markwith: So, that's when Julie was like, "Okay, what meetings do they have? Okay, just invite yourself and start attending." And I was like, "Oh yeah, I'm a part of administration." So, I started going to them and they're like, "Oh yeah, you should go to this meeting." I'm like, "I'm here." So, that was how I did that to just get into the system and understanding the intricacies behind what was going on, how we're serving our patients.

Host: Yeah. So, let me ask you this then, in your opinion, what qualities do you feel makes someone a good risk manager?

Karen Markwith: So, I think they have to have that critical thinking. They have to be open-minded, understand that there are three, four, six parts to a story and just so focus on the first thing you hear. Really, investigation, be trusting, form relationships, those are all really important.

And then, a really good quality that I admire in my team is when they keep on asking why, why, why, why, because I know that's part of the root cause, but there's also this understanding of there are system errors and there's human factors. It affects the human. The human affects the system. So, what caused all of this? Go back, back to the why, why, why, why, why. And then, you're going to find this ripple effect of something that maybe the system error occurred months ago, but it's now trickling down and it's reaching the patient. So, really digging in, that's a great quality to continue to develop. And you need to form good relationships within the team so that when you ask them why they're not offended, they want to work with you. They know that you're a trusted part of the team. You're not being adversarial. And then, just always be learning. Always be learning.

Host: That's good advice for all of us. You said make sure you're a critical thinker. Be open minded. You said be investigative. You have to build trust, and it's important to build those relationships as well. And then, always ask why and keep digging. So, those are really great qualities to have for a risk manager. So, I'm sure you're a mentor now to up and coming risk managers. What advice do you have for someone who's early on in their career and might come to you and say, "Karen, help me out. What should I be paying attention to? What should I do early on in my career?"

Karen Markwith: One thing that I've told my staff numerous times, you know, and something I've done in my own professional and personal life is I had a motivational speaker. He gave some great advice one time, his name was Andy Andrews and he does a lot of lectures on PBS. And one of them was on you need to build your personal board of directors. Board of directors on your professional life, board of directors on your personal life. So, you're trying to improve your marriage, you find people on your board of directors that improve marriages and you interview them. Same thing with your professional life. So, I say, build your board of directors. Now, those people don't know they're on your board. You just picked them as a good representation. They give good presentations or they do good investigation series. You go and put them on your board and then you start interviewing them. You start meeting with them, take them to coffee, take them to lunch. Start really building on those attributes that they have so you can start embodying those attributes and build your own success with that, whatever you're trying to improve on.

So, that's what I do all the time. So, I ask my risk managers, build your personal and professional board of directors, because whatever characteristics you want to apply to your profession, go find those people. And you don't need to let them know you're on my board of directors. You just say, "I really liked the way she does that, or he does that. I'm going to start working with him and see how he does that." So, that helps them build more, obviously, confidence in their role.

And the other piece that they come to me and say, ""I'm sure you've done this before. I'm sure you've dealt with this before." And nine out of 10 times, I'm like, "Probably not." Risk is so diverse, so interesting, so different. Every time I said, "Let's work through this problem together. Maybe I have some experience with it, but it's always different. We need to apply what we know and then work through that. So, there's always other questions. Work it with another team member too is always a good experience. Good advice.

Host: So, build your professional board of directors. That's great advice. And then, you said when you encounter problems, you approach it as, "Hey, let's work through this together and we'll figure it out together." So, I think that's great. So, let me ask you this, a question about ASHRM. When and how did you first get involved with ASHRM? When did ASHRM come into your professional career?

Karen Markwith: Well, like I said, when I first had my first job as a risk manager with a medical group that had just formed, and then of course they were part of a health system that was part of CHI and the CHI is self-insured, so they had their own risk program. So, they sent all their risk managers to ASHRM. So, I was at my first ASHRM, I'm not going to say the year, a long time ago. And my first ASHRM was like three months into my job. So, it was like, "Wow, this is a lot of information." I, just like a sponge, went and thought this is great information. And then, I already attended an education session with my state organization. So, I knew this was just a wealth of great resources. And so, that's how I started being involved with ASHRM.

And then, you know, you applied to be a volunteer and I got picked to be a volunteer to help with the Risk Management Awareness Week, which was a lot of fun. And then, I stepped back and said, "Okay, I didn't really do well at that volunteer job. I could have done better. I need to improve my skills. And so, years later, another volunteer applications came out for a new committee for a Content Committee. And I applied and I got it. And the Content Committee was just astronomically so important and just gave me such a wealth of information. I helped produce or publish the playbook on ambulatory care for risk managers right up my alley. And then, I helped with the writing of the risk management handbook that was published a couple of years ago. So, it was really great experience being part of that Content Committee.

Then, I was asked to, "Hey, you might want to be interested in the Conference committee," which I was. So, I got into the Conference Committee, and worked there and became the Chair of the Conference Committee a couple years ago, which was just wonderful. So great experience. And then, one of my peers nominated me to be part of the board. So, I got elected to the board in '23. So, right now, I'm in my second year being a board member. So, just a great journey. Great mentors throughout within the ASHRM leadership. And so, it's just always been a great, positive experience.

Host: Well, it certainly sounds like it. So, you've been on several committees here, the content committee, the conference committee, you're now a board member. And you said within three months, you had exposure to ASHRM, so very early on in your career, which I think is wonderful. So, let me ask you this, for the younger risk managers that are coming up, do you encourage them to get involved in both a national and local level in their careers? So, for someone coming to you, why would you say, "Hey, you need to get involved with ASHRM and get involved"?

Karen Markwith: I point out all the resources. The Exchange, which is great. It's like reading every day. I always go to the Exchange. The Exchange has a great library. So, you can go back search for a specific topic, which has been so helpful to me and seeing what everybody is sharing, all the tools, which is just great, great community. And then, of course, the resources, the playbooks, they've got now flashcards, the podcast, the journal. And just so many resources to help increase our experience or knowledge on all the different types of risks coming through in healthcare and what other people are doing about it, just a great depth of knowledge and experience there. And then, of course, your state program also has great education too. And so, I'm encouraging my staff to always go to one of those. We do webinars. I myself have done a couple of webinars. And so, they of course dial in, but there's other things that are always being offered. So, I'm always pushing that offering and we're actually using the CPHRM flashcards right now as part of our work group, and they love them. Using those resources and then applying them to your work has been such a great positive for them.

Host: So, for someone starting out, where would you suggest someone starts? For someone who does want to get involved, where should they start?

Karen Markwith: I would go to the local level first and then volunteer for ASHRM opens up at the end of the calendar year. So, apply. There's no harm, no foul for applying. We love new members. We love their focus and their point of view, their diversity. That's all needed in our professional group. So, getting those new people, new risk managers involved in these volunteers really does help them, helps us. So, I really encourage them to volunteer for their local state as well as ASHRM, because there's lots of opportunities out there. Even if you don't get picked, good for you for trying. The board members are always out there, we're helping, we go to our local state chapters. So, just lean in a little bit. Pick us up, email us. You know, we'd love to talk to you. So, that's my advice, is just don't think that you're alone on this journey, especially if you're one risk manager for a big hospital and you're like, "Okay, what do now?" We've got lots of resources that can help you be successful.

Host: Yeah. So, start at the local level, like you said, or state level, raise your hand, volunteer, and that's how you get started. So, that's great advice. Well, Karen, this has really been fun talking with you and learning about you and your career in risk management. Before we wrap up, is there anything else you want to add about your journey or anything you want to say to up and coming risk managers?

Karen Markwith: My advice to up and coming risk managers is find a mentor, find many mentors. Get your board of directors put together and start reaching out to them so you can grow your own professional experience as well as your confidence and competence. I think that's really important. And then, of course, you know, invite yourself to meetings, lean in. Make yourself invaluable. Get the trust going with your great peers or professional groups, people that you work with. Build those relationships and that's like the cornerstone or the platform for success.

Host: Yep. Make yourself invaluable. I love that. So, that's wonderful. Karen, thank you so much for your time today. It's been a pleasure talking with you.

Karen Markwith: Thank you.

Host: Yeah. And once again, that is Karen Markwith. And the ASHRM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more. Thanks for listening.